FORT WORTH, Texas – Women at high risk for breast cancer should consider annual mammograms at age 30 – or even younger in some cases – and adding an ultrasound or MRI exam to their screenings, under new American Cancer Society guidelines.
The national health organization is also focusing on the need for older women to continue annual screenings and cited substantial benefits of mammograms for women in their 40s.
The guidelines, published in this month’s edition of “CA: A Cancer Journal for Clinicians,” are the first major change in breast cancer screening recommendations since 1997.
“Ultrasound and MRI can pick up things that are not found on mammography,” said Dr. Marilyn Leitch, a surgery professor at the University of Texas Southwestern Medical Center at Dallas who served on the American Cancer Society’s guidelines work group. “And mammography can pick up things those methods can’t see.”
Leitch said insurance companies might pay for magnetic resonance imaging for women who can provide solid evidence that they are at high risk for breast cancer.
Factors that increase a person’s risk for breast cancer include a family or personal history of the disease, never having children or bearing children later in life.
Scientific evidence that supports annual mammograms beginning at age 40 is increasing, said Dr. Phil Evans, a Texas radiologist who also served on a guidelines work group. Breast cancer can be more aggressive in younger women, and Evans said that supports the need for women over 40 to get mammograms yearly rather than every other year as once prescribed.
For the first time, the American Cancer Society’s guidelines address women who might believe – incorrectly – that they are too old to be screened by mammograms.
As for women 40 to 50, the society’s guidelines remained unchanged and call for annual screenings.
The value of routine mammograms for younger women has been hotly debated for years.
Critics have said that mammograms are unreliable in younger women because false negatives occur more often than in older women. A 2001 Denmark study concluded that the benefits of screening younger women did not justify the risks, including unnecessary surgery.
After recommending monthly breast self-exams beginning at age 20 in 1997, the American Cancer Society now has revised them to say women may opt to skip them.
“There’s no clear evidence that self-exams reduce mortality,” Evans said. “But we do know breast self-exams increase awareness and help women understand changes in their breasts.”
The American Cancer Society encourages women to report any changes to their physician.
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(c) 2003, Fort Worth Star-Telegram.
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Distributed by Knight Ridder/Tribune Information Services.
AP-NY-05-15-03 2159EDT
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